[Pharmwaste] New ABC News report of unused medications
Fred.Massoomi at nmhs.org
Wed Feb 24 16:05:34 EST 2010
Where Should the Unused Meds Go?
Politicians Want to Give Unused Drugs to Charity, But Much of it Gets
By LAUREN COX
ABC News Medical Unit
Feb. 24, 2010-
Photos go to relatives and the knickknacks might go to a garage sale,
but who wants to deal with the array of unused pills when grandma passes
Some politicians do.
In the last year, state legislators across the country have proposed
bills aimed at curbing the disposal of unused medication. Colorado,
Maine, Minnesota, Maryland and Washington have all proposed legislation
that in one way or another tries to address the issue ofmedicines that
end up in landfills and watersheds
story?id=9249373> every year.
Bills in some states, such as Colorado, want nursing homes to be free to
donate the unused medication
s/story?id=8774859> to charities that help developing countries. Bills
in other states attempt to divert unused medication back to manufacturer
-- and are facing resistance from pharmaceutical companies.
But whoever is fighting over the unused medicine, all involved hope that
no one flushes them down the toilet.
"Probably about 50 percent of the medications that are sent to my
nursing home from the pharmacy end up having to be destroyed," said
Maxine Roby, an administrator at Rowan Community -- a 66-bed nursing
home facility in Denver, Colo.
Roby said the waste at her nursing home is not unusual. In fact, by
regulation it's often unavoidable. When a doctor writes a prescription
eeded/story?id=9408999> at a nursing home, the pills aren't dispensed
as they would be from a local pharmacy.
The pills are shipped from the pharmaceutical company
oversy/story?id=9700748> on 30-day supply cards -- each pill snugly in
its own "bubble" so the nurse can pop it out. But, Roby explained, if a
patient has a bad reaction to the medicine after one day and stops
taking it, or even passes away, nurses are required to get rid of the
"They [pharmaceutical manufacturers
nt-change-practices/story?id=8476391> ] will not take the drugs back, I
don't even know why. Once they give it to us, where stuck with them,"
"A lot of people would just flush them," said Roby. But "we were
notified by the Denver Water board, that they have no way to filter
medications out of the drinking water."
Since water treatment plants across the country have no way of filtering
out pharmaceutical waste -- which can come from bodily fluids as well as
unused medicine -- more and more environmental groups are encouraging
people to dispense of the medication in the trash and hospitals to
incinerate leftover medicine.
To Donate or Flush?
The home alternative to flushing is to follow the U.S. Environmental
Protection Agency guidelines. Mixed unused medication with something
unsavory -- like kitty litter -- to keep it away from animals and seal
it in a container for the landfill so it does not dissolve and leach
"That's a big issue. That's why they're telling people put your medicine
in kitty litter, or in coffee grounds and throw them away," said
Colorado Democratic state Senator Lois Tochtrop who co-sponsored the
bill, HB 10-1061, Colorado Medical Donation Program.
Tochtrop had no clear estimation of exactly how much medication could be
saved through his bill. Few estimates of how much medical waste is
generated have even been done. A 2009 investigation by The Associated
Press estimated that at least 250 million pounds of pharmaceuticals and
contaminated packaging is generated in medical facilities each year.
Tochtrop noted whatever medicine is saved, will go not only to
international charities such as Project Cure, but also local ones.
"The need is endless in the developing world. One of the largest things
they ask for is medications, and it's the hardest to ship," said George
Roberge, vice president of operations at Project Cure.
Of course not all medicines can be donated, even from nursing homes
where packaging would make it easier to safely keep medicine. Roberge
noted that Project Cure can't accept open packaging, liquids, expired
medicine, narcotics or even medicine that's is not expired but that
stayed at a nursing home longer than a year.
But Tochtrop and Roby, who testified before the state legislature in
support of the Colorado bill, think every little bit will help.
The medicines that are thrown away, "are going to our landfills then
those medications will leach into our ground water eventually," said
But across the country in Maine, a measure meant to reduce medical waste
is shaping into a bit of a public debate about the dangers in landfills.
What About the Take Back Approach?
Often called "take back" programs, state legislators in Maine, Minnesota
and Washington are proposing, the medicines from homes (not nursing
homes) should be the responsibility of pharmaceutical companies. Rather
than encouraging citizens to flush unused medications or throw them
away, the waste could be picked up along with other hazardous waste such
as mercury, and disposed of at the pharmaceutical companies' expense.
The Pharmaceutical companies are resisting this kind of legislation. "We
know that it [unused medicine] does not leech from landfills," said
Marjorie Powell, senior assistant general counsel for Pharmaceutical
Research and Manufacturers of America, PhRMA.
PhRMA has come out in opposition to many of the bills that require
pharmaceutical companies be responsible for the disposal of unused
medications. However, Powell said that PhRMA began looking into the fate
of unused medication years ago.
"When PhRMA learned that there were trace amounts of compounds in
[water] we were approached by the U.S. Fish and Wildlife Service," said
Powell. "They said 'why are these there?', and we said we think it's
because people have a habit of flushing unused medicine down the
But, Powell argued rather than having medicine shipped to the
pharmaceutical companies for disposal, more public education on how to
properly throw away medication would solve environmental concerns.
"We think they (take back programs) cause more environmental harm than
they solve, we think they're unnecessary," Powell said of the bills.
However, Scott Cassel, executive director at the Product Stewardship
Institute, disagreed with Powell's assertion that dissolved medicine
would not leech out of landfills. He also questioned whether having
pharmaceutical companies dispose of the medication would be a challenge,
since the industry already incinerates leftover medication from
pharmacies in private take back programs.
What Really Happens To Unused Medicine?
"Putting it in the trash, in the landfills doesn't mean that it won't
get in the water," said Cassel.
The EPA is unsure and has funded a plethora of studies to track
pharmaceuticals contamination from hospitals, from farms, and from human
"Recent studies have documented the presence of various pharmaceutical
chemicals and metabolic by-products in surface waters and groundwater in
the United States, and the issue of pharmaceutical use and management
has become increasingly important," the EPA wrote on its Web site in its
proposal to add pharmaceuticals to the Universal Waste Rule
<http://www.epa.gov/waste/hazard/wastetypes/universal/pharm.htm> . "EPA
is conducting research on the presence of pharmaceutical compounds in
water bodies and any ecological effects the compounds may be causing, as
well as research directed towards improving water treatment
Cassel said the Product Stewardship Institute has attempted to
facilitate talks between state government and pharmaceutical industry
representatives to address the problem. He said both sides can agree not
to tell people to flush medicine down the toilet.
But, "it's too expensive for the local governments to take it back,"
Cassel noted. "They feel like they want to do something, they want to
protect their citizens but they don't have the funding to do it."
"At this point we got a lot of work ahead of us, I think this bill might
have a chance at really making it all the way through," said Maine state
Senator Anne C. Perry , a Democrat, who introduced the measure in Maine.
"It's still not a definite, and we got a lot of work to do."
Copyright (c) 2010 ABC News Internet Ventures
Firouzan 'Fred' Massoomi, Pharm.D., FASHP
Nebraska Methodist Hospital
Pharmacy Operations Coordinator
Department of Pharmacy Services
8303 Dodge St.
Omaha, NE 68114
fred.massoomi at nmhs.org <mailto:fred.massoomi at nmhs.org>
(402) 354-4340 office (402) 354-3139 fax
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